Officials at two major Roman Catholic policy groups expressed fears Friday that President Barack Obama's revised health insurance mandate still poses a moral quandary because it could override an exemption in Illinois law that allows Catholic institutions to avoid offering birth control to their employees.

"It forces us back into a position that we find untenable," said Patrick Cacchione, executive director of the Illinois Catholic Health Association. "We're not going to pay or provide or participate in something that we think is immoral."

Since 2003, Illinois law has required insurance companies to include contraceptive coverage in policies sold to Illinois companies. However, an exemption allows self-insured employers — which includes most major Catholic institutions — to offer insurance that does not cover contraceptives.

State officials are reviewing the revised federal mandate and are also unsure how it will affect the state's law and its exemption for self-insured employers, a spokeswoman for the Illinois Department of Insurance said.

Under a revised mandate issued by the administration Friday, employees at Catholic and other religious hospitals, charities and universities would have access to free contraception through their insurance companies. Obama had earlier pitched a plan that would have required employers to offer health insurance that covered birth control at no cost.

Cacchione, whose organization represents the state's Catholic health facilities, called the changes to the mandate "a shell game" and said Obama seemed more intent on addressing the political controversy than the ethical questions raised by the mandate's opponents.

"It might mitigate his political problem, but it certainly doesn't solve our concern," he said.

Cardinal Francis George was in Rome and not available for comment on Friday. George wrote a letter early this week in reference to Obama's original proposal, saying "We cannot — we will not — comply with this unjust law." George asked that the letter be read at all Masses this weekend.

The Chicago Archdiocese on Friday referred to a statement from Archbishop Timothy Dolan, president of the U.S. Conference of Catholic Bishops, who said the changes are "a first step in the right direction" but "we reserve judgment on the details until we have them."

Officials with several Catholic institutions in the Chicago area said they needed more time to determine how the changes could affect the health insurance they offer employees.

Robert Gilligan, executive director of the Catholic Conference of Illinois, said he is "still very concerned about" about the administration's insurance mandate.

"We don't have enough information to make an informed decision," said Gilligan. "We're still looking at it. We have questions about how the proposal will work, and I think once those are answered, we'll have a better way to discern what our position is on this."

The White House maintained that covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services.

The insurance companies, which will have to carry the cost of providing birth control coverage for religious institutions unwilling to do so, aren't convinced. Insurers worry that shifting the cost burden on to them in this instance would mean more costs would come their way down the road.

"Insurance companies are concerned that it might set a precedent," said Bonnie Washington, senior vice president at Avalere Health LLC, a Washingtonbased health care industry consulting firm. "Figuring out how to do this operationally will present a challenge. Just the cost of changing systems, changing forms, changing processes is a concern."